Migrant health: call for inclusion « Healthy migrants, healthy Thailand: Improving health condition of migrants in priority provinces of Thailand » ECOSOC.

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Migrant health: call for inclusion « Healthy migrants, healthy Thailand: Improving health condition of migrants in priority provinces of Thailand » ECOSOC Innovation Fair 2009 Jacqueline Weekers Snr Migration Health Policy Advisor, Migration Health Department, IOM

IOM is……. Intergovernmental body 125 Member States >400 offices globally Committed to the principle that humane and orderly migration benefits migrants and societies MHD: promote migrants health & advise States and partners

Objectives Health as a component to a positive migration outcome Key determinants to migrant health Effective practices towards inclusiveness: Thailand Migrant Health Pogramme

Migration today

Reality of inequalities begs for inclusive approach Well-managed migrant health benefits all Facilitates integration: healthy migrants are productive members of society Stabilizes societies Inclusion

Does migration affect health? Migration is in and of itself is not a risk-factor to health The circumstances surrounding the migration process can pose risks to health

Diversity in types of migrating persons: labour migrants, IDPs, irregular migrants, returnees, refugees, immigrants,… The most vulnerable: those with irregular status those forced to move, those who suffer discrimination and exploitation Identify the vulnerable

Health determinants transit origin return destination No access to health but many risk factors

Migrant Health Programme, Thailand ongoing Assists the government to improve health and well-being of migrants & host communities in Thailand through the provision of comprehensive, participatory, sustainable and cost-effective health services. Partners: health authorities at national, provincial and community level; immigration bureau, detention centres, NGOs, UN, international donors and private sector. Healthy Migrants, Healthy Thailand Chiang Rai Tak Samutsakorn Bangkok Ranon g Pang Nga

Barriers to health services Financial burden (e.g. out of pocket; costs of migrant health insurance) Fear of deportation Language and cultural Lack info about services Hard to reach, no transport Negative attitudes Mobility

Inferior health status Only 50% seek care compared to 78% among Thai 77% incomplete immunization; 50% measles coverage 12% malaria compared to 1.5% among Thai Migrant sex workers HIV rate 21.3% Abortion rate is 2.4 times higher than among Thai 16% access to clean water; <50% sanitation, waste disposal MDR TB linked to mobility Leading cases reported: Malaria, diarrhea, fever, Pneumonia. (sources: Provincial health offices; WHO; MoPH; IOM; UNDP)

Strategies: capacity building Capacity building of all counterparts: health care providers authorities migrants 84 MCHW; >1000 MCHV; MOPH officers

Strategies: Migrant friendly services Migrant friendly services: Community Health Workers & Voluteers; Accessible: mobile/outreach Linguist. & cult. Appropriate 10 community health posts, 56 health corners; (e.g. > reached for health education; > Rx; > contraceptive use; >antenatal cases threefold; > immunization coverage)

Strategies: multi sectoral network Coordination among sectors and partners Provincial Migrant Health Committee Coordination Centre for Migrant Health Migrant Working Group Bi annual migrant health conference MHP GovernmentMigrants UN partners, IOs AcademiaEmployers Health sector

Strategies: positive policies Advocate for positive migrant health policies and support their implementation Border health strategy Migrant health stratey Migrant health financing

What worked? Country ownership PHC pillars & HSS Connect countries Rights based Involve community Inclusive: access to all Across sectors

Some challenges Crisis leading to tougher rules for registration and increased threat for deportation of the undocumented Health insurance not available to all Need for mix of external and government financial support Hard to research migrant health Hard to provide cross border services due to political situation

Publications 2007: Assessment of Mobility and HIV Vulnerability among Myanmar Migrant Sex Workers and Factory Workers in Mae Sot District, Tak Province, Thailand 2008: Migration and HIV/AIDS in Thailand: A desk review of migrant labour sectors 2009: Avian and Human Influenza Pandemic Preparedness Plan in 4 Piloted Districts of Chaing Rai Province, Thailand Soon coming out: 2009: Financing health care for Migrants: A case study from Thailand 2009: Migration and HIV/AIDS in Thailand: Comprehensive data analysis in 10 provinces of Thailand 2009: Environmental Health Assessment in Selected Migrant Communities in Thailand 2009: IOM-MOPH Migrant Health Program Model: A summary of good practices, achievements and lessons learned

Please come and visit us Integrated migrant health services